1
|
Okuda DT, Azevedo CJ, Pelletier D, Moog TM, Moazami S, Rezvani S, Bovis F, Sormani MP, Siva A, Kantarci O, Lebrun-Frénay C. Dimethyl fumarate preserves brainstem and cervical spinal cord integrity in radiologically isolated syndrome. J Neurol 2024:10.1007/s00415-024-12514-x. [PMID: 38980342 DOI: 10.1007/s00415-024-12514-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND AND PURPOSE The first randomized placebo-controlled therapeutic trial in radiologically isolated syndrome (RIS), ARISE, demonstrated that treatment with dimethyl fumarate (DMF) delayed the onset of a first clinical event related to CNS demyelination and was associated with a significant reduction in new and/or newly enlarging T2-weighted hyperintense lesions. The purpose of this study was to explore the effect of DMF on volumetric measures, including whole brain, thalamic, and subcortical gray matter volumes, brainstem and upper cervical spine three-dimensional (3D) volumes, and brainstem and upper cervical spine surface characteristics. METHODS Standardized 3T MRIs including 3D isotropic T1-weighted gradient echo images were acquired at baseline and end-of-study according to the ARISE study protocol. The acquired data were analyzed using Structural Image Evaluation Using Normalization of Atrophy (SIENA), FreeSurfer v7.3, and an in-house pipeline for 3D conformational metrics. Multivariate mixed models for repeated measures were used to analyze rates of change in whole brain, thalamic, subcortical gray matter, as well as change in the 3D surface curvature of the dorsal pons and dorsal medulla and 3D volume change at the medulla-upper cervical spinal cord. RESULTS The study population consisted of 64 RIS subjects (DMF:30, placebo:34). No significant difference was seen in whole brain, thalamic, or subcortical gray matter volumes in treated vs. untreated RIS patients. A significant difference was observed in dorsal pons curvature with the DMF group having a lower least squares mean change of - 4.46 (standard estimate (SE): 3.77) when compared to placebo [6.94 (3.71)] (p = 0.036). In individuals that experienced a first clinical event, a greater reduction in medulla-upper cervical spinal cord volume (p = 0.044) and a decrease in surface curvature was observed at the dorsal medulla (p = 0.009) but not at the dorsal pons (p = 0.443). CONCLUSIONS The benefit of disease-modifying therapy in RIS may extend to CNS structures impacted by neurodegeneration that is below the resolution of conventional volumetric measures.
Collapse
Affiliation(s)
- Darin T Okuda
- Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, 5303 Harry Hines Blvd., Dallas, TX, 75390-8806, USA.
- Peter O'Donnell Jr. Brain Institute, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | | | | | - Tatum M Moog
- Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, 5303 Harry Hines Blvd., Dallas, TX, 75390-8806, USA
- Peter O'Donnell Jr. Brain Institute, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Saeed Moazami
- University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Aksel Siva
- University of Cerrahpasa School of Medicine, Istanbul, Turkey
| | | | | |
Collapse
|
2
|
Krieger S, Cook K, Hersh CM. Understanding multiple sclerosis as a disease spectrum: above and below the clinical threshold. Curr Opin Neurol 2024; 37:189-201. [PMID: 38535979 PMCID: PMC11064902 DOI: 10.1097/wco.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW Research in multiple sclerosis (MS) has long been predicated on clinical groupings that do not reflect the underlying biologic heterogeneity apparent within patient populations. This review explicates the various levels of explanation through which the spectrum of disease is described and investigated both above and below the clinical threshold of detection, as framed by the topographical model of MS, to help advance a cogent mechanistic framework. RECENT FINDINGS Contemporary evidence has amended the view of MS as consisting of sequential disease phases in favor of a spectrum of disease with an admixture of interdependent and dynamic pathobiological axes driving tissue injury and progression. Recent studies have shown the presence of acute and compartmentalized inflammation and mechanisms of neurodegeneration beginning early and evolving throughout the disease continuum. Still, the gap between the understanding of immunopathologic processes in MS and the tools used to measure relevant molecular, laboratory, radiologic, and clinical metrics needs attention to enable better prognostication of disease and monitoring for changes along specific pathologic axes and variable treatment outcomes. SUMMARY Aligning on a consistently-applied mechanistic framework at distinct levels of explanation will enable greater precision across bench and clinical research, and inform discourse on drivers of disability progression and delivery of care for individuals with MS.
Collapse
Affiliation(s)
- Stephen Krieger
- Corinne Goldsmith Dickinson Center for MS, Icahn School of Medicine at Mount Sinai
| | - Karin Cook
- Medical Education Director, Neurology at Heartbeat/Publicis Health, New York
| | - Carrie M. Hersh
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic Lou Ruvo Center for Brain Health, Cleveland Clinic Las Vegas, Nevada, USA
| |
Collapse
|
3
|
Epstein SE, Longbrake EE. Shifting our attention earlier in the multiple sclerosis disease course. Curr Opin Neurol 2024; 37:212-219. [PMID: 38546031 DOI: 10.1097/wco.0000000000001268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024]
Abstract
PURPOSE OF REVIEW Revisions of multiple sclerosis (MS) diagnostic criteria enable clinicians to diagnose patients earlier in the biologic disease course. Prompt initiation of therapy correlates with improved clinical outcomes. This has led to increased attention on the earliest stages of MS, including the MS prodrome and radiologically isolated syndrome (RIS). Here, we review current understanding and approach to patients with preclinical MS. RECENT FINDINGS MS disease biology often begins well before the onset of typical MS symptoms, and we are increasingly able to recognize preclinical and prodromal stages of MS. RIS represents the best characterized aspect of preclinical MS, and its diagnostic criteria were recently revised to better capture patients at highest risk of conversion to clinical MS. The first two randomized control trials evaluating disease modifying therapy use in RIS also found that treatment could delay or prevent onset of clinical disease. SUMMARY Despite progress in our understanding of the earliest stages of the MS disease course, additional research is needed to systematically identify patients with preclinical MS as well as capture those at risk for developing clinical disease. Recent data suggests that preventive immunomodulatory therapies may be beneficial for high-risk patients with RIS; though management remains controversial.
Collapse
|
4
|
Lebrun-Frenay C, Kantarci O, Siva A, Azevedo CJ, Makhani N, Pelletier D, Okuda DT. Radiologically isolated syndrome. Lancet Neurol 2023; 22:1075-1086. [PMID: 37839432 DOI: 10.1016/s1474-4422(23)00281-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/29/2023] [Accepted: 07/17/2023] [Indexed: 10/17/2023]
Abstract
Individuals can be deemed to have radiologically isolated syndrome (RIS) if they have incidental demyelinating-appearing lesions in their brain or spinal cord that are highly suggestive of multiple sclerosis but their clinical history does not include symptoms consistent with multiple sclerosis. Data from international longitudinal cohorts indicate that around half of people with RIS will develop relapsing or progressive symptoms of multiple sclerosis within 10 years, suggesting that in some individuals, RIS is a presymptomatic stage of multiple sclerosis. Risk factors for progression from RIS to clinical multiple sclerosis include younger age (ie, <35 years), male sex, CSF-restricted oligoclonal bands, spinal cord or infratentorial lesions, and gadolinium-enhancing lesions. Other imaging, biological, genetic, and digital biomarkers that might be of value in identifying individuals who are at the highest risk of developing multiple sclerosis need further investigation. Two 2-year randomised clinical trials showed the efficacy of approved multiple sclerosis immunomodulatory medications in preventing the clinical conversion to multiple sclerosis in some individuals with RIS. If substantiated in longer-term studies, these data have the potential to transform our approach to care for the people with RIS who are at the greatest risk of diagnosis with multiple sclerosis.
Collapse
Affiliation(s)
- Christine Lebrun-Frenay
- CRC-SEP Nice, Neurologie CHU Nice, Hôpital Pasteur 2, UMR2CA-URRIS, Université Côte d'Azur, Nice, France.
| | | | - Aksel Siva
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Turkiye
| | - Christina J Azevedo
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Naila Makhani
- Departments of Pediatrics and Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Daniel Pelletier
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Darin T Okuda
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
5
|
Abou Mrad T, Naja K, Khoury SJ, Hannoun S. Central vein sign and paramagnetic rim sign: From radiologically isolated syndrome to multiple sclerosis. Eur J Neurol 2023; 30:2912-2918. [PMID: 37350369 DOI: 10.1111/ene.15922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
The widespread use of magnetic resonance imaging (MRI) has led to an increase in incidental findings in the central nervous system. Radiologically isolated syndrome (RIS) is a condition where imaging reveals lesions suggestive of demyelinating disease without any clinical episodes consistent with multiple sclerosis (MS). The prognosis for RIS patients is uncertain, with some remaining asymptomatic while others progress to MS. Several risk factors for disease progression have been identified, including male sex, younger age at diagnosis, and spinal cord lesions. This article reviews two promising biomarkers, the central vein sign (CVS) and the paramagnetic rim sign (PRS), and their potential role in the diagnosis and prognosis of MS and RIS. Both CVS and PRS have been shown to be accurate diagnostic markers in MS, with high sensitivity and specificity, and have been useful in distinguishing MS from other disorders. Further research is needed to validate these findings and determine the clinical utility of these biomarkers in routine practice.
Collapse
Affiliation(s)
- Tatiana Abou Mrad
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Kim Naja
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Salem Hannoun
- Medical Imaging Sciences Program, Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
6
|
Bower A, Makhani N. Radiologically Isolated Syndrome and the Multiple Sclerosis Prodrome in Pediatrics: Early Features of the Spectrum of Demyelination. Semin Pediatr Neurol 2023; 46:101053. [PMID: 37451751 DOI: 10.1016/j.spen.2023.101053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 07/18/2023]
Abstract
Radiologically isolated syndrome refers to the clinical scenario in which individuals have imaging concerning for multiple sclerosis and would otherwise satisfy radiographic dissemination in space criteria, but do not have any attributable signs or symptoms. Radiologically isolated syndrome has been increasingly recognized in the pediatric population and it is understood certain individuals will transition to a formal diagnosis of multiple sclerosis over time. This review aims to outline the available data within this unique population including the diagnostic criteria, epidemiology, risk factors associated with transitioning to multiple sclerosis, and the current therapeutic landscape. Radiologically isolated syndrome will also be positioned within a broader spectrum of demyelinating disease as recent data has pointed towards a likely prodromal phase that precedes a first clinical event and diagnosis of multiple sclerosis. Characterizing the radiographic features, clinical symptoms, and biomarkers that constitute this prodromal phase of multiple sclerosis would help identify patients who may most benefit from early intervention in the future.
Collapse
Affiliation(s)
- Aaron Bower
- Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Naila Makhani
- Department of Neurology, Yale School of Medicine, New Haven, CT; Department of Pediatrics, Yale School of Medicine, New Haven, CT.
| |
Collapse
|
7
|
Collorone S, Foster MA, Toosy AT. Advanced central nervous system imaging biomarkers in radiologically isolated syndrome: a mini review. Front Neurol 2023; 14:1172807. [PMID: 37273705 PMCID: PMC10235479 DOI: 10.3389/fneur.2023.1172807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Radiologically isolated syndrome is characterised by central nervous system white-matter hyperintensities highly suggestive of multiple sclerosis in individuals without a neurological history of clinical demyelinating episodes. It probably represents the pre-symptomatic phase of clinical multiple sclerosis but is poorly understood. This mini review summarises our current knowledge regarding advanced imaging techniques in radiologically isolated syndrome that provide insights into its pathobiology and prognosis. The imaging covered will include magnetic resonance imaging-derived markers of central nervous system volumetrics, connectivity, and the central vein sign, alongside optical coherence tomography-related metrics.
Collapse
Affiliation(s)
| | | | - Ahmed T. Toosy
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
| |
Collapse
|
8
|
Tremlett H, Munger KL, Makhani N. The Multiple Sclerosis Prodrome: Evidence to Action. Front Neurol 2022; 12:761408. [PMID: 35173664 PMCID: PMC8841819 DOI: 10.3389/fneur.2021.761408] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/14/2021] [Indexed: 01/10/2023] Open
Abstract
A growing body of work points toward the existence of a clinically symptomatic prodromal phase in multiple sclerosis (MS) that might span 5–10 years or more. A prodrome is an early set of signs or symptoms predating the onset of classical disease, which in turn predates a definitive diagnosis. Evidence for a prodromal phase in MS could have major implications for prevention, earlier recognition and treatment, as well as an improved disease course or prognosis. This Perspective provides a succinct overview of the recent advances in our understanding of the MS prodrome and current key challenges. Many of the MS prodromal features characterized thus far are non-specific and are common in the general population; no single feature alone is sufficient to identify an individual with prodromal MS. Biomarkers may increase specificity and accuracy for detecting individuals in the MS prodromal phase, but are yet to be discovered or formally validated. Progress made in the elucidation of prodromal phases in other neurological and immune-mediated diseases suggests that these barriers can be overcome. Therefore, while knowledge of a prodromal phase in MS remains nascent, how best to move from the rapidly growing evidence to research-related action is critical. Immediate implications include refining the concept of the MS continuum to include a prodromal phase. This will help inform the true “at risk” period when considering exposures that might cause MS. Major long-term implications include the earlier recognition of MS, improved prognosis, through earlier disease management, and the future possibility of MS disease prevention.
Collapse
Affiliation(s)
- Helen Tremlett
- Faculty of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
- *Correspondence: Helen Tremlett
| | | | - Naila Makhani
- Departments of Pediatrics and Neurology, Yale School of Medicine, New Haven, CT, United States
| |
Collapse
|
9
|
A Distinct Hibiscus sabdariffa Extract Prevents Iron Neurotoxicity, a Driver of Multiple Sclerosis Pathology. Cells 2022; 11:cells11030440. [PMID: 35159249 PMCID: PMC8834068 DOI: 10.3390/cells11030440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 02/04/2023] Open
Abstract
Iron deposition in the brain begins early in multiple sclerosis (MS) and continues unabated. Ferrous iron is toxic to neurons, yet the therapies used in MS do not counter iron neurotoxicity. Extracts of Hibiscus sabdariffa (HS) are used in many cultures for medicinal purposes. We collected a distinct HS extract and found that it abolished the killing of neurons by iron in culture; medications used in MS were ineffective when similarly tested. Neuroprotection by HS was not due to iron chelation or anthocyanin content. In free radical scavenging assays, HS was equipotent to alpha lipoic acid, an anti-oxidant being tested in MS. However, alpha lipoic acid was only modestly protective against iron-mediated killing. Moreover, a subfraction of HS without radical scavenging activity negated iron toxicity, whereas a commercial hibiscus preparation with anti-oxidant activity could not. The idea that HS might have altered properties within neurons to confer neuroprotection is supported by its amelioration of toxicity caused by other toxins: beta-amyloid, rotenone and staurosporine. Finally, in a mouse model of MS, HS reduced disability scores and ameliorated the loss of axons in the spinal cord. HS holds therapeutic potential to counter iron neurotoxicity, an unmet need that drives the progression of disability in MS.
Collapse
|
10
|
Freeman L, Longbrake EE, Coyle PK, Hendin B, Vollmer T. High-Efficacy Therapies for Treatment-Naïve Individuals with Relapsing-Remitting Multiple Sclerosis. CNS Drugs 2022; 36:1285-1299. [PMID: 36350491 PMCID: PMC9645316 DOI: 10.1007/s40263-022-00965-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/11/2022]
Abstract
There are > 18 distinct disease-modifying therapy (DMT) options covering 10 mechanisms of action currently approved by the US Food and Drug Administration for the treatment of relapsing-remitting multiple sclerosis (RRMS). Given the multitude of available treatment options, and recent international consensus guidelines offering differing recommendations, there is broad heterogeneity in how the DMTs are used in clinical practice. Choosing a DMT for newly diagnosed patients with MS is currently a topic of significant debate in MS care. Historically, an escalation approach to DMT was used for newly diagnosed patients with RRMS. However, the evidence for clinical benefits of early treatment with high-efficacy therapies (HETs) in this population is emerging. In this review, we provide an overview of the DMT options and MS treatment strategies, and discuss the clinical benefits of HETs (including ofatumumab, ocrelizumab, natalizumab, alemtuzumab, and cladribine) in the early stages of MS, along with safety concerns associated with these DMTs. By minimizing the accumulation of neurological damage early in the disease course, early treatment with HETs may enhance long-term clinical outcomes over the lifetime of the patient.
Collapse
Affiliation(s)
- Léorah Freeman
- Department of Neurology, Dell Medical School, The University of Texas at Austin, 1601 Trinity St, Austin, TX, 78701, USA.
| | | | - Patricia K. Coyle
- Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY USA
| | - Barry Hendin
- Banner, University Medicine Neurosciences Clinic, Phoenix, AZ USA
| | - Timothy Vollmer
- Department of Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO USA
| |
Collapse
|
11
|
Mechanism-based criteria to improve therapeutic outcomes in progressive multiple sclerosis. Nat Rev Neurol 2021; 18:40-55. [PMID: 34732831 DOI: 10.1038/s41582-021-00581-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 02/07/2023]
Abstract
In contrast to the multiple disease-modifying therapies that are available for relapsing-remitting multiple sclerosis (MS), the therapeutic options for progressive MS (PMS) are limited. Recent advances in our understanding of the neuroimmunology of PMS, including the mechanisms that drive slowly expanding lesions, have fuelled optimism for improved treatment of this condition. In this Review, we highlight the commonly observed neuropathology of PMS and discuss the associated mechanisms of CNS injury. We then apply this knowledge to formulate criteria for therapeutic efficacy in PMS, beginning with the need for early treatment owing to the substantial neuropathology that is already present at the initial clinical presentation. Other requirements include: antagonism of neuroaxonal injury mediators such as pro-inflammatory microglia and lymphocytes; remediation of oxidative stress resulting from iron deposition and mitochondrial dysfunction; and promotion of neuroprotection through remyelination. We consider whether current disease-modifying therapies for relapsing-remitting MS meet the criteria for successful therapeutics in PMS and suggest that the evidence favours the early introduction of sphingosine 1-phosphate receptor modulators. Finally, we weigh up emerging medications, including repurposed generic medications and Bruton's tyrosine kinase inhibitors, against these fundamental criteria. In this new therapeutic era in PMS, success depends collectively on understanding disease mechanisms, drug characteristics (including brain penetration) and rational use.
Collapse
|
12
|
Abstract
A prodrome is an early set of signs, symptoms or other findings that occur before the onset of typical symptoms of a disease. Prodromal phases are well recognized in several neurological and inflammatory diseases, but the possibility of a prodrome in multiple sclerosis (MS) has received relatively little attention until the past few years. In this Perspective, we summarize what is currently known about the MS prodrome, including its possible duration, clinical features and potential biomarkers. We also consider what insights and lessons can be learned from knowledge of and research into the prodromal phases of other diseases. A better understanding of the MS prodrome could have profound clinical implications as it could enable earlier recognition of MS and earlier initiation of treatments that reduce relapse rates and long-term disability. Knowledge of the MS prodrome could also affect research into the causes of MS, and putative risk factors must be re-evaluated in light of the MS prodrome. We conclude by outlining the major knowledge gaps and propose future initiatives.
Collapse
Affiliation(s)
- Naila Makhani
- Departments of Pediatrics and of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Helen Tremlett
- Faculty of Medicine (Neurology), The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.,
| |
Collapse
|
13
|
Carvalho V, Soares C, Gomes I, Carvalho A, Serrazina F, Rodrigues SG, Pinheiro J, Marques IB, Correia F, Correia AS, de Sá J, Sousa L, Vale J, Sá MJ, Sousa C, Ferreira J. RISCOP-Cognitive profile in a Portuguese cohort of radiological isolated syndrome patients: A case-control study. Mult Scler Relat Disord 2021; 50:102832. [PMID: 33596492 DOI: 10.1016/j.msard.2021.102832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/31/2021] [Accepted: 02/05/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Radiologically isolated syndrome (RIS) refers to the incidental discovery of white matter lesions suggestive of MS, on brain MRI, in asymptomatic patients. Recent studies suggest similar features of cognitive impairment between RIS and MS patients. Also, lower levels of health-related quality of life (QOL) and fatigue are reported in such patients. AIMS characterize and compare the cognitive profile of a multicentric Portuguese cohort of RIS patients with a control group. METHODS multicentric comparative study of a cohort of adult patients with RIS, and age and gender-matched controls followed in the headache outpatient clinic with prior MRI not fulfilling criteria for RIS diagnosis. We conducted interviews with participants, collected clinical data and applied the BICAMS battery and self-reported questionnaires (HADS, MFIS, MSQOL-54). RESULTS we evaluated 31 patients with RIS (median age 46 years, IQR [(Dusankova et al., 2012-52], 72% women) and 19 control individuals (median age 32 years, IQR [(O'Jile et al., 2005-48], 71% women). Prevalence of cognitive impairment did not differ between groups (16% of the RIS and 10% of the controls, p=0.579). We found no differences between groups on the BICAMS tests, although the results of the California Verbal Learning Test (CVLT-II) score presented a trend to significance, with a lower value on the RIS group (53.9 vs. 59.3, p=0.066). There were no significant differences regarding fatigue, QOL, anxiety/depression scores. CONCLUSION this is the first study on a Portuguese cohort of RIS patients assessing cognitive profile with BICAMS. A non-neglectable part of our cohort presented cognitive impairment. Our findings add to previous studies in suggesting that a more pronounced impairment of verbal memory and learning, evaluated by CVLT-II, may be present in RIS patients compared to controls. BICAMS should be assessed on future studies with larger cohorts.
Collapse
Affiliation(s)
- Vanessa Carvalho
- Department of Neurology, Hospital Pedro Hispano/Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.
| | - Carolina Soares
- Department of Neurology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
| | - Inês Gomes
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Andreia Carvalho
- Department of Neurology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Filipa Serrazina
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | | | - Joaquim Pinheiro
- Department of Neurology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Filipe Correia
- Department of Neurology, Hospital Pedro Hispano/Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Ana Sofia Correia
- Department of Neurology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; CEDOC, Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - João de Sá
- Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
| | - Lívia Sousa
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José Vale
- Department of Neurology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Maria José Sá
- Department of Neurology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal; Health Sciences Faculty, Universidade Fernando Pessoa, Porto, Portugal
| | - Cláudia Sousa
- Department of Psychology, Centro Hospitalar Universitário de São João, EPE, Porto, Portugal
| | - João Ferreira
- Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
| |
Collapse
|
14
|
Barreiro-González A, Sanz MT, Carratalà-Boscà S, Pérez-Miralles F, Alcalá C, Carreres-Polo J, España-Gregori E, Casanova B. Magnetic resonance imaging and optical coherence tomography correlations in multiple sclerosis beyond anatomical landmarks. J Neurol Sci 2020; 419:117180. [PMID: 33091751 DOI: 10.1016/j.jns.2020.117180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/14/2020] [Accepted: 10/10/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate multiple sclerosis (MS) optical coherence tomography (OCT) cross-sectional correlations with central nervous system (CNS) magnetic resonance imaging (MRI). MATERIAL AND METHODS Peripapillary retinal nerve fiber layer (pRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner (INL) and outer nuclear layer (ONL) of 54 relapsing remitting (RRMS) and 38 progressive (PMS, 9 primary and 29 secondary) patients were measured. With less than 3 months brain parenchymal fraction (BPF), spinal cord (SC), total gray matter (GM) and white matter volumes were calculated. Demographical and clinical data was compared according to the history of optic neuritis (HON). Relationships between OCT and MRI data were assessed using multivariable linear regression models, adjusting for age, gender and disease duration, taking into account HON and disease subtype. RESULTS Cerebellum (p = 0.008), pRNFL (p = 0.001), GCL (p = 0.001) and IPL (p = 0.001) were thinner, while INL was thicker (p = 0.02) if HON. SC correlated better with nasal pRNFL sectors in eyes with HON (all eyes: average pRNFL p = 0.035 η2 = 0.213; N-pRNFL p = 0.04 η2 = 0.36, NI-pRNFL p = 0.0001 η2 = 0.484. RRMS eyes: N-pRNFL p = 0.034 η2 = 0.348; NI-pRNFL p = 0.013 η2 = 0.441), while it correlates with PMB (p = 0.032 η2 = 0.144), GCL (p = 0.03 η2 = 0.147) and IPL (p = 0.028 η2 = 0.151) in eyes without HON regardless of the disease subtype. INL presented no microcystic macular oedema and was inversely associated with BPF (p = 0.029 η2 = 0.363) and cerebellum (p = 0.015 η2 = 0.428) in PMS eyes without HON. CONCLUSIONS OCT data correlates with different CNS compartments, even with no anatomical or functional linkage, serving as useful neurodegeneration and inflammation surrogate marker.
Collapse
Affiliation(s)
| | - Maria T Sanz
- Departamento de Didáctica de la Matemática, Universidad de Valencia, Valencia, Spain
| | - Sara Carratalà-Boscà
- Neuroimmunology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Carmen Alcalá
- Neuroimmunology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Joan Carreres-Polo
- Radiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Enrique España-Gregori
- Ophthalmology Department, La Fe University and Polytechnic Hospital, Valencia, Spain; Surgery Department, Faculty of Medicine, University of Valencia, Spain
| | - Bonaventura Casanova
- Neuroimmunology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain; Medicine Department, Faculty of Medicine, University of Valencia, Spain
| |
Collapse
|
15
|
Kabaeva AR, Boyko AN, Kulakova OG, Favorova OO. [Radiologically isolated syndrome: prognosis and predictors of conversion to multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:7-12. [PMID: 32844624 DOI: 10.17116/jnevro20201200727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Increased sensitivity and availability of magnetic resonance imaging (MRI) in neurological routine practice led to the fact that more and more experts began to encounter changes typical for multiple sclerosis (MS) according to MRI in the absence of anamnestic and clinical indications of damage to the central nervous system (CNS). This nosological form has been defined as a radiologically isolated syndrome (RIS). More and more RIS cases convert to MS (up to 30% in the first 5 years after RIS diagnosis). At the moment, there are no biological markers that allow combining RIS and MS into one pathological process and early treatment with disease-modifying drugs (DMT). Prospective studies are actively being conducted to identify demographic, clinical, neuroimaging and biochemical conversion predictors. The identification of the molecular biological RIS features, combining these changes with MS, is an urgent scientific task and will allow timely initiation of therapy of the pathological process already at the subclinical stage.
Collapse
Affiliation(s)
- A R Kabaeva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia.,Federal Center of Cerebrovascular Pathology and Stroke, Moscow, Russia
| | - O G Kulakova
- Pirogov Russian National Research Medical University, Moscow, Russia.,Institute of Experimental Cardiology of National Medical Research Center of Cardiology, Moscow, Russia
| | - O O Favorova
- Pirogov Russian National Research Medical University, Moscow, Russia.,Institute of Experimental Cardiology of National Medical Research Center of Cardiology, Moscow, Russia
| |
Collapse
|
16
|
Hosseiny M, Newsome SD, Yousem DM. Radiologically Isolated Syndrome: A Review for Neuroradiologists. AJNR Am J Neuroradiol 2020; 41:1542-1549. [PMID: 32763896 DOI: 10.3174/ajnr.a6649] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/04/2020] [Indexed: 12/24/2022]
Abstract
Radiologically isolated syndrome refers to an entity in which white matter lesions fulfilling the criteria for multiple sclerosis occur in individuals without a history of a clinical demyelinating attack or alternative etiology. Since its introduction in 2009, the diagnostic criteria of radiologically isolated syndrome and its clinical relevance have been widely debated by neurologists and radiologists. The aim of the present study was to review the following: 1) historical evolution of radiologically isolated syndrome criteria, 2) clinical and imaging findings in adults and children with radiologically isolated syndrome, 3) imaging features of patients with radiologically isolated syndrome at high risk for conversion to MS, and 4) challenges and controversies for work-up, management, and therapeutic interventions of patients with radiologically isolated syndrome.
Collapse
Affiliation(s)
- M Hosseiny
- From the Department of Radiological Sciences (M.H.), David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - S D Newsome
- Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - D M Yousem
- Russell H. Morgan Department of Radiology and Radiological Sciences (D.M.Y.), Johns Hopkins Medical Institution, Baltimore, Maryland.
| |
Collapse
|
17
|
Ruggieri S, Bharti K, Prosperini L, Giannì C, Petsas N, Tommasin S, Giglio LD, Pozzilli C, Pantano P. A Comprehensive Approach to Disentangle the Effect of Cerebellar Damage on Physical Disability in Multiple Sclerosis. Front Neurol 2020; 11:529. [PMID: 32695059 PMCID: PMC7338682 DOI: 10.3389/fneur.2020.00529] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/13/2020] [Indexed: 12/24/2022] Open
Abstract
Cerebellar damage occurs frequently in multiple sclerosis (MS) patients, with a wide exhibition of symptoms particularly as impairments of balance and gait. Recent studies implementing new postprocessing magnetic resonance imaging (MRI) techniques showed how cerebellar subregional atrophy provides an explanation of disability in MS. The aim of this work was to evaluate the relationship between quantitative measures of physical disability, cerebellar subregional atrophy, and cerebellar peduncle disruption. Forty-nine MS patients and 32 healthy subjects as controls (HS) underwent a 3-Tesla MRI including 3D T1-weighted and diffusion tensor imaging. Patients underwent static posturography to calculate the body's center of pressure (COP) displacement, Expanded Disability Status Scale (EDSS), and 25-ft walking test (25-FWT). Cerebellar lobular volumes were automatically calculated using the Spatially Unbiased Infratentorial Toolbox. Tract-based spatial statistics (TBSS) in FSL was used to process diffusion tensor imaging (DTI) Fit-generated fractional anisotropy (FA) maps to assess structural connectivity of cerebellar peduncles. Stepwise multivariate linear regression analyses were used to explore relationships between variables. Cerebellar volumes (anterior and posterior, as well as lobular volumes from I to X) were significantly lower in patients with MS than HS (p < 0.05). FA in all cerebellar peduncles was lower in MS patients than in HS (p < 0.05). EDSS and 25-FWT showed an association with atrophy of lobule VIIIb (β = −0.37, p < 0.01, and β = −0.45, p < 0.001, respectively) COP measures inversely correlated with volume of lobules I–IV (β = −0.37, p < 0.01, and β = −0.36, p < 0.01). Lower FA in the three cerebellar peduncles of MS patients positively correlated with cerebellar lobular volumes. Our findings show how sensorimotor cerebellum atrophy and disruption of both afferent and efferent cerebellar connections contribute to physical disability in MS patients.
Collapse
Affiliation(s)
- Serena Ruggieri
- Department of Human Neurosciences, "Sapienza" Rome University, Rome, Italy.,Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Komal Bharti
- Department of Human Neurosciences, "Sapienza" Rome University, Rome, Italy
| | - Luca Prosperini
- Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy
| | - Costanza Giannì
- Department of Human Neurosciences, "Sapienza" Rome University, Rome, Italy
| | | | - Silvia Tommasin
- Department of Human Neurosciences, "Sapienza" Rome University, Rome, Italy
| | - Laura De Giglio
- Department of Human Neurosciences, "Sapienza" Rome University, Rome, Italy
| | - Carlo Pozzilli
- Department of Human Neurosciences, "Sapienza" Rome University, Rome, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, "Sapienza" Rome University, Rome, Italy.,Department of Radiology, IRCCS Neuromed, Pozzilli, Italy
| |
Collapse
|